ABSTRACT
There can be no denying that while a woman uses certain drugs, there are risks to the foetus during pregnancy, and different, possibly even more damaging, risks later from within the home. A harm reduction approach tries to set limits on these risks rather than attempt to remove them; for example, by controlling drug use rather than advocating abstinence. This is not seen as good enough by critics of this philosophy because using drugs is seen as a choice and there is an ‘innocent child’ that will be hurt. The combination of these two words tends to induce a variety of emotional reactions that in the context of drug use may initiate protective action on behalf of the child and restraining, often punitive, action against the mother. The common answer to this is to point out that reality dictates a more pragmatic approach, one that avoids repressive and moralising actions, since these only alienate drug users and may interfere with treatment and control outcomes. The critical task for services is to safeguard the child and yet cultivate the bond with a drug-using mother. Accepting that there are significant risks to the child, what is the best way of minimising them?
